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expert reaction to paper on e-cigarettes and spending on health services in the US

A paper published in Tobacco Control looks at healthcare utilisation and expenditures attributable to current e-cigarette use among US adults.


Prof Jamie Brown, Professor of Behavioural Science and Health and Director of the Tobacco and Alcohol Research Group at University College London, said:

“These results appear to be based on two key assumptions.

“First, that the identified associations between e-cigarette use and poor health status are caused by e-cigarettes. The majority of people who use e-cigarettes are also former or current cigarette smokers. Despite the attempts at adjustment, it is likely that at least some of the association is actually caused by cigarettes.

“The second assumption appears to be that the alternative is simply that these people would not be using e-cigarettes. However, we know that e-cigarettes help people to quit smoking cigarettes and that cigarette smoking causes enormous healthcare expenditure. Therefore, the key question is what is the net impact on healthcare utilisation, when trying to account for how e-cigarettes affect how many people smoke cigarettes? These types of models have tended to suggest net benefits are likely. For example:


Prof Peter Hajek, Director of the Tobacco Dependence Research Unit, Queen Mary University of London (QMUL), said:

“This is a baffling piece of work. The authors report that people who use e-cigarettes have poorer health and incur higher health costs than non-smokers, but it is not clear why they assume that the excess health expenditure incurred by smokers who are trying to limit their smoking by using e-cigarettes (often because of acute health problems) is caused by their recent vaping rather than by their lifetime smoking. This is like claiming that the extra health expenditure incurred by people with broken legs is caused by using crutches.” 



‘Healthcare utilisation and expenditures attributable to current e-cigarette use among US adults’ by Yingning Wanget al. was published in Tobacco Control at 23.30 UK time on Monday 23 May.

DOI: 10.1136/tobaccocontrol-2021-057058



Declared interests

Prof Peter Hajek: “No conflict of interest.”

No others received



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